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Bosutinib

Description
Chemotherapy Protocol Chronic Myeloid Leukaemia Bosutinib Regimen • Bosutinib Indication • As an option for the treatment of patients wi
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/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/CML/Bosutinib.pdf

Taking oral systemic anti-cancer therapy (SACT) - patient information

Description
This factsheet gives information about taking oral systemic anti-cancer therapy (SACT).
Url
/Media/UHS-website-2019/Patientinformation/Cancercare/Taking-oral-systemic-anti-cancer-therapy-SACT-3103-PIL.pdf

Everolimus-Exemestane

Description
Regimen Chemotherapy Protocol BREAST CANCER EVEROLIMUS and EXEMESTANE • Breast Cancer – Everolimus-Exemestane Indication • The first or second line treatment of post-menopausal metastatic breast cancer where the following criteria are met; - ER positive and HER2 negative - no symptomatic visceral disease - previous treatment with a non-steroidal aromatase inhibitor - no previous treatment with exemestane • Performance status 0, 1, 2 Toxicity Drug Everolimus Exemestane Adverse Effect Diarrhoea, rash, dry skin, fatigue, non-infectious pneumonitis, increased risk of infection, hyperglycaemia, hypertriglyceridaemia Fractures, hot flushes, headache, increased sweating, joint and muscloskeletal pain, insomnia, fatigue, nausea The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring • FBC, U&Es and LFTs every 4 weeks • Blood glucose levels at baseline and after 4 weeks of treatment. Thereafter every 4-8 weeks or as clinically indicated • Lipids and proteinuria at baseline then as clinically indicated • In those with osteoporosis or at risk of this disease consider bone densitometry before starting exemestane • Hepatitis serology at baseline • Respiratory assessment at baseline Dose Modifications The dose modifications listed are for haematological, liver and renal function and drug specific toxicities only. Dose adjustments may be necessary for other toxicities as well. Version 1 (June 2018) Page 1 of 7 Breast-Everolimus-Exemestane In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. Haematological Consider blood transfusion or the prescription of an erythropoietin produce according to NICE TA 323 if the patient is symptomatic of anaemia or has an haemoglobin of less than 8g/dL (80g/L). Neutrophils (x109/L) Dose Modifications (Everolimus) 1 or greater Full dose 0.5 - 1 less than 0.5 or NCI-CTC grade 3 febrile neutropenia NCI-CTC grade 4 febrile neutropenia 1st Occurrence Interrupt treatment until recovery to 1x109/L or greater then restart at the full dose 2nd Occurrence Interrupt treatment until recovery to 1x109/L or greater then restart at 5mg once a day 1st Occurrence Interrupt treatment until the fever has resolved and the neutrophils are 1x109/L or greater then restart at 5mg once a day 2nd Occurrence Discontinue treatment permanently Discontinue treatment permanently Platelets (x109/L) Dose Modifications (Everolimus) 75 or greater 50-75 25-50 less than 25 Full dose 1st Occurrence Interrupt treatment until recovery to 75x109/L or greater then restart at the full dose 2nd Occurrence Interrupt treatment until recovery to 75x109/L or greater then restart at 5mg once a day 1st Occurrence Interrupt treatment until recovery to 75x109/L or greater then restart at 5mg once a day 2nd Occurrence Discontinue treatment permanently Discontinue treatment permanently Version 1 (June 2018) Page 2 of 7 Breast-Everolimus-Exemestane Hepatic Impairment Drug Exemestane Everolimus Child Pugh Class Not Applicable A B C Dose Use with caution 7.5mg once a day 5mg once a day If benefit–risk assessment is considered favourable by the consultant, treat with a maximum daily dose of 2.5mg once a day Renal Impairment Drug Creatinine Clearance (ml/min) Dose (% of original dose) Everolimus Exemestane N/A No dose modification required NA Use with caution Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. For all other non-haematological NCI-CTC grade 3 and above toxicities delay treatment until the adverse effect has resolved to NCI-CTC grade 1 or below. The dose should then be reduced to 5mg once a day or discontinued as appropriate. Diabetes If blood glucose is raised at baseline or the patient is a known diabetic then attempt to optimise the glycaemic control before starting everolimus. After commencing everolimus, if the fasting glucose is between 14-27.8mmol/L or the triglycerides are in the range 5.8-11.4mmol/L then interrupt everolimus until resolved. Restart the everolimus at 5mg once a day. If the fasting glucose is greater than 27.8mmol/l or triglycerides are greater than 11.4mmol/L then discontinue everolimus. Version 1 (June 2018) Page 3 of 7 Breast-Everolimus-Exemestane Mucositis NCI-CTC Grade 2 3 or recurrence of grade 2 mucositis 4 or recurrence of grade 3 mucositis Action (Everolimus) Continue the everolimus without dose adjustments if the patient can tolerate it. Alternatively interrupt until symptoms have resolved to NCICTC grade 1 or below and then re-challenge at the same dose Interrupt treatment until symptoms have resolved to NCI-CTC grade 1 or below then restart the everolimus at 5mg once a day Discontinue everolimus Non Infectious Pneumonitis Patients who develop non-specific respiratory signs and symptoms such as hypoxia, pleural effusion, cough or dyspnoea should be advised to report promptly. Some cases of noninfectious pneumonitis, including severe and fatal cases, were described in 12% of patients taking everolimus For patients who develop radiological changes suggestive of non-infectious pneumonitis and have few, moderate or severe symptoms see the table below. NCI-CTC Grade 1 2 3 4 Action (Everolimus) Continue everolimus without dose adjustments Interrupt therapy. Consider short term use of corticosteroids e.g. prednisolone 20mg once a day for 10-14 days. Restart everolimus at 5mg once a day when symptoms have resolved. Interrupt therapy. Prescribe corticosteroids e.g. prednisolone 40mg as indicated. Restart everolimus at 5mg daily once symptoms have resolved or discontinue as appropriate. Discontinue the everolimus. Treat appropriately. Infections Everolimus has immunosuppressant properties and may increase the risk of bacterial, fungal, viral or protozoal infections (including opportunistic, viral reactivation). Pre- existing infections should completely resolve before starting everolimus treatment; doses should be delayed if infection occurs. Avoid if possible in carriers of hepatitis B and C and monitor carefully for signs of hepatitis re-activation. If a diagnosis of invasive systemic fungal infection is made, everolimus treatment should be promptly and permanently discontinued with appropriate antifungal therapy. Regimen 28 day cycle continued as long as clinical benefit is observed or until unacceptable toxicity occurs (6 cycles will be set in Aria) Drug Everolimus Dose 10mg once a day Days 1-28 inclusive Administration Oral Exemestane 25mg once a day 1-28 inclusive Oral Version 1 (June 2018) Page 4 of 7 Breast-Everolimus-Exemestane Dose Information • Everolimus is available as 2.5mg, 5mg and 10mg tablets. • Exemestane is available as a 25mg tablet. Administration Information • For everolimus, take at the same time of day every day with or without food, but not after a high fat meal. • For exemestane take with or just after food, or a meal. • If a dose is missed do not take an additional but rather take the next scheduled dose Additional Therapy • Mouthcare for the prophylaxis or treatment of mucositis in accordance with local guidelines • Gastric protection with a proton pump inhibitor or a H2 antagonist may be considered in patients considered at high risk of GI ulceration or bleed. Additional Information • The National Patient Safety Alert on oral chemotherapy (NPSA/2008/RRR001) must be followed in relation to everolimus. • It must be made clear to all staff, including those in the community, that everolimus should only be prescribed under the supervision of an oncologist. • Everolimus interacts with many other agents. Always check for drug interactions. Coding • Procurement – X71.5 • Delivery – X73.1 References 1. Baselga J, Compone M, Piccart M et al. Everolimus in post-menopausal hormone receptor positive advanced breast cancer. N Engl J Med 2012; 366 (6): 520-529. Version 1 (June 2018) Page 5 of 7 Breast-Everolimus-Exemestane REGIMEN SUMMARY Everolimus-Exemestane Day 1 1. Everolimus 10mg once a day oral Administration Instructions Swallow this medicine whole. Do not crush or chew. 2. Exemestane 25mg once a day oral Administration Instructions Take with or just after food, or a meal. Version 1 (June 2018) Page 6 of 7 Breast-Everolimus-Exemestane DOCUMENT CONTROL Version Date Amendment Written By Approved By 1 June 2018 None Dr Deborah Wright Pharmacist Dr Chern Lee Consultant Medical Oncologist This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; Hampshire Hospitals NHS Foundation Trust NHS Isle of Wight Portsmouth Hospitals NHS Trust Salisbury Hospitals NHS Foundation Trust University Hospital Southampton NHS Foundation Trust Western Sussex Hospitals NHS Trust All actions have been taken to ensure these protocols are correct. However, it remains the responsibility of the prescriber to ensure the correct drugs and doses are prescribed for patients. These protocols should be read in conjunction with other reference sources such as the Summary of Product Characteristics or published references Version 1 (June 2018) Page 7 of 7 Breast-Everolimus-Exemestane
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Breastcancer/Everolimus-Exemestane.pdf

Monoclonal antibody treatment for asthma - patient information

Description
Patient information factsheet Monoclonal antibody treatment for asthma We have sent you this factsheet because you are on the waiting list for monoclonal antibody treatment. This is an additional, injection-based, biologic treatment for your asthma, on top of your usual inhalers and tablets. This was discussed with you in one of your appointments with your doctor. We are sending this information to help answer any questions you might have. If you have any further questions, please ask your nurse or doctor. What are biologics? Biologics are a group of drugs used to help with uncontrolled difficult asthma which is not responding to maximal treatment with inhalers and/or tablets. They work in different ways and are tailored to each individual. We will decide which treatment is suitable for you based on the results of your previous blood tests. The treatments are in injection form only. They are given at different frequencies, from fortnightly to monthly to every two months, depending on the medication chosen. When we decide on the best treatment, we will consider these practicalities. There are two ‘types’ of asthma that can be treated by biologic injections: allergic asthma and eosinophilic asthma. People with allergic asthma can have biologic treatment by injection if: • they have a positive skin prick test in reaction to certain airborne allergens, AND • their blood test results show raised immunoglobulin (IgE, antibodies in the immune sys- tem). People with eosinophilic asthma have raised eosinophils (a type of white blood cell involved in allergies) on blood tests (and sometimes in sputum or biopsies). These eosinophils are believed to cause the inflammation involved in the development of asthma symptoms. Starting your treatment We will send you a letter to let you know the date of the start of your treatment. We will try to book you in with plenty of time to make arrangements for work or your daily routine. For your first few appointments, we will ‘trial’ the treatment with you to see whether it works for you. www.uhs.nhs.uk Patient information factsheet What to expect at your first injection or infusion appointment Please book in at the respiratory centre reception desk to let us know that you are here. A clinic nurse will call you in when it is time for your appointment and you will have various tests. You will be familiar with spirometry (blowing into a machine) and measurement of fractionated exhaled nitric oxide (FENO). There will also be a number of questionnaires to give us an idea of your current status before you start the treatment. A member of the medical team will ask you to sign a consent form and give you an opportunity to ask any questions about the treatment. Some injection medications will be prepared in the room. Others are pre-filled syringes or premade bags of solution which are ready to use. This will depend on the type of drug you need. Some of the drugs, once made up, have to be used (or thrown away). This is why it is important to let us know in plenty of time if you cannot make the appointment. Your first three appointments for injections or infusions of any of the biologic drugs will last for two hours each. You will need to stay for the full two hours and you will be observed in the clinic room for any reactions. Before you leave the clinic you will be told who to contact if you have a delayed reaction. If you have a reaction and need to go to a GP or hospital for treatment, please tell them that you have had this treatment. You will need to come back in after two, four or eight weeks, depending on the treatment. Please book your next appointment in at reception before you leave. This will ensure that we are expecting you and have prepared your medication in time for your appointment. After the trial period When you have finished your trial, we will discuss whether it is best to carry on with the treatment. If you continue with the treatment, you may be able to have your treatment at home in the long run. It is very important that you come to your follow-up appointments. If your symptoms have not improved after the trial and we decide that it is best not to continue, your doctor will discuss the alternatives with you. Follow-up appointments There are two types of follow-up appointments: • Follow-up appointments while we are assessing whether the treatment will work for you You will need to come in for your first few appointments as explained above. We will ob serve you for 30 to 60 minutes depending on your reaction. If you are having an intravenous infusion, we will need to observe you for 30 to 60 minutes after the normal saline has been flushed through. • Follow-up appointments once we have seen that the treatment is working These will be scheduled on different days of the week. We will let you know about any changes. The appointment will last for about 30 minutes. We will not need to do as many assessments as during the trial. www.uhs.nhs.uk Patient information factsheet Will the treatment definitely work? We cannot guarantee this, but we have chosen the treatment because we think there is a good chance the treatment will improve things. Decisions about whether the treatment is working (and/or working ‘well enough’) will be made either at the end of the trial, or in some cases part way through (to allow us to try other treatments rather than persisting with something that doesn’t work). These decisions will be made by a multi-disciplinary team, with input from your doctor, and taking your views into account. NHS England have strict criteria which we need to follow to continue with the treatment. Changing or cancelling your appointment If you need to move your appointment to a different date please contact the respiratory centre on 023 8120 4325 and leave a message if necessary. Please do not contact patient services or the ‘Choose and book’ service, as we will not be able to note your changes. Risks and side effects The most common side effects of monoclonal injections are: • redness at the injection site • discomfort at the injection site • headaches Some people may have a fever and abdominal pain. It is also common to feel tired on the day of the injection. Omalizumab In very rare cases (an estimated 0.1 to 0.2% of cases), Omalizumab treatment can cause anaphylaxis (a severe and potentially life-threatening allergic reaction). This is most common during the first three injections, but can occasionally happen when someone has been having the treatment for a long time. Reslizumab Risks and side effects of Reslizumab include: • muscle pain, known as myalgia • anaphylaxis Mepolizumab Risks and side effects of Mepolizumab include: • upper abdominal (tummy) pain • reaction to the injection • back pain • eczema • fever • headache • allergic reactions • increased risk of infection • a stuffy nose www.uhs.nhs.uk Patient information factsheet Benralizumab Risks and side effects of Benralizumab include: • fever • headache • allergic reactions, which may be delayed • sore throat After your injections, we will observe you to check for any signs of a reaction to the treatment, especially after each of your first three injections. Travel Your immune system may be less effective during your treatment, so you may be more likely to pick up infections. If you are planning to travel abroad, please speak to your doctor. They will be able to advise you. Alternative treatments This is an additional treatment to manage difficult asthma. You will need to continue with your current inhaled therapies. If you have concerns about this treatment, please discuss these with your doctor. Useful links If you have any questions or concerns, please speak to your doctor or the asthma and allergy nurses in the clinic. They will also be able to give you more information about the specific treatment you are having at the clinic. Asthma UK website www.asthma.org.uk/ Omalizumab bnf.nice.org.uk/drug/omalizumab.html Reslizumab bnf.nice.org.uk/drug/reslizumab.html Mepolizumab public.gsk.co.uk/search-results.html?_charset_=utf-8&q=mepolizumab&%3Acq_csrf_ token=undefined Benralizumab www.medicines.org.uk/emc/product/8918 If you need a translation of this document, an interpreter or a version in large print, Braille or on audio tape, please telephone 023 8120 4688 for help. Version 2. Updated February 2020. Due for review February 2023. 2320 www.uhs.nhs.uk
Url
/Media/UHS-website-2019/Patientinformation/Respiratory/Monoclonal-antibody-treatment-for-asthma2320.pdf

HSCTCyclophosphamide Priming (1500)

Description
Chemotherapy Protocol Haematopoietic Stem Cell Transplant (Autograft) CYCLOPHOSPHAMIDE PRIMING (1500mg/m2) Regimen • Haematopoietic Stem Cell Transplant
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Transplant/HSCTCyclophosphamide-Priming-1500.pdf

Temozolomide (150)

Description
Chemotherapy Protocol Central Nervous System TEMOZOLOMIDE (150) Regimen • CNS – Temozolomide (150) Indication • First li
Url
/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/CNS/Temozolomide-150.pdf

AmB-(TICE)-Carboplatin-Etoposide

Description
Chemotherapy Protocol GERM CELL Amb TICE (Part 2): Carboplatin – Etoposide phosphate Ambulatory Regimen This regimen is for AMBULATORY CARE pathway use only use only and will only be available to prescribe at units which carry out autograft transplantation. This treatment regimen consists of two parts: 2 cycles of TI (Paclitaxel and Ifosfamide) followed by 3 cycles of CE (Carboplatin and Etoposide) with PBSC autologous transplant. Regimen • Germ Cell – Amb TICE (part 2): Carboplatin and Etoposide phosphate Indication • Conditioning for autologous peripheral blood stem cell transplant (PBSCT) / bone marrow transplant in individuals with relapsed and refractory metastatic germ cell tumours. Toxicity Drug Carboplatin Etoposide Adverse Effect Neuropathy, hypersensitivity, nephrotoxicity, ototoxicity Hypotension on rapid infusion, hyperbilirubinaemia The adverse effects listed are not exhaustive. Please refer to the relevant Summary of Product Characteristics for full details. Monitoring Drugs • EDTA or calculated creatinine clearance before the 1st cycle. • FBC, LFTs and U&Es prior to each cycle Dose Modifications The dose modifications listed are for haematological, liver and renal function only. Dose adjustments may be necessary for other toxicities as well. In principle all dose reductions due to adverse drug reactions should not be re-escalated in subsequent cycles without consultant approval. It is also a general rule for chemotherapy that if a third dose reduction is necessary treatment should be stopped. Version 1.0 (December 2025) Page 1 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate Please discuss all dose reductions / delays with the relevant consultant before prescribing, if appropriate. The approach may be different depending on the clinical circumstances. The following is a general guide only. Haematology Treatment will be given regardless of blood results. Consider blood transfusion if patient symptomatic of anaemia or has a haemoglobin of less than 8g/dL. Irradiated blood products must be used. Hepatic Impairment Drug Carboplatin Bilirubin µmol/L AST/ALT units Dose (%of original dose) No adjustment necessary Etoposide (as 26-51 or etoposide phosphate) more than 51 or 60-180 more than 180 50 clinical decision Renal Impairment Drug Carboplatin Creatinine Clearance Dose (ml/min) (% of original dose) Less than 50 Do not use Changes in the GFR of more than 10% between cycles may require dose adjustment more than 50 100 Etoposide (as 15-50 75 etoposide phosphate) less than 15 50 Other Dose reductions or interruptions in therapy are not necessary for those toxicities that are considered unlikely to be serious or life threatening. For example, alopecia, altered taste or nail changes. Regimen The starting dose of carboplatin AUC8 is maxed at 1200mg; unless GFR is measured using EDTA and patient is over 18 in which case dose can exceed 1200mg after consultant review (ref NCI/CTEP letter Ivy et al 2010) Etoposide phosphate (Etopophos) must be used for this protocol as solutions of conventional etoposide would exceed the maximum concentration of 0.4 mg/mL and may precipitate. Version 1.0 (December 2025) Page 2 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate NOTE: 1 mg of etoposide = 1.136 mg etopophos (etoposide phosphate). Doses in this protocol are expressed as etoposide whereas all administration details in this protocol refer to Etoposide phosphate. Consider a dose reduction in poor performance patients. It should be noted that the dose of carboplatin may need to be altered if there is a change (improvement or reduction) in renal function of more than 10% from the previous cycle. 21 day cycle for 3 cycles Drug Carboplatin Dose AUC8 Days -5, -4, -3 Administration Intravenous infusion in 500ml glucose 5% over 60 minutes Etoposide (as etoposide phosphate) 400mg/m2 -5, -4, -3 Intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Dose Information • Carboplatin will be dose banded according to the national dose band (10mg/ml) • Etoposide dose will be rounded to the nearest 100mg (up if halfway) Administration Information Extravasation • Carboplatin – irritant • Etoposide - irritant Additional Therapy This regimen is to be administered in the ambulatory setting. Please ensure all supportive and take-home medicines are prescribed on the in-patient chart or general electronic prescribing system if patient requires admission. Please refer to the transplant schedule for each individual patient. This therapy may lead to the development of tumour lysis syndrome at the start of therapy. Patients should be assessed and for those patients deemed high risk allopurinol should be prescribed. This should begin the day before chemotherapy treatment and continue for as long as a significant chemo-sensitive tumour bulk remains. • Antiemetics - Starting 15-30 minutes prior to chemotherapy: Aprepitant 125mg once only orally on the day -5 then 80mg once a day for the subsequent two days - dexamethasone 2mg twice a day for 3 days oral or intravenous starting on day -5 of the cycle Version 1.0 (December 2025) Page 3 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate - metoclopramide 10mg three times a day for 10 days oral or intravenous starting on day -5 of the cycle - ondansetron 8mg twice a day oral or intravenous • Anti-infectives - aciclovir 400mg oral twice a day - ciprofloxacin 250mg oral twice a day from day +1 (stop when neutrophils are greater than 1) - fluconazole 100mg once a day oral (stop when neutrophils are greater than 1 unless the patient remains on corticosteroids) - nystatin suspension 1ml four times a day oral (stop when neutrophils are greater than 1 unless the patient remains on corticosteroids) • Thromboprophylaxis, to be started on Day +5, unless patient has been deemed high risk. To be continued until platelets are less than 50x109/L, or as directed by the consultant, according to VTE risk assessment and local formulary choices: - dalteparin 5000units once a day subcutaneous injection - enoxaparin 40mg once a day subcutaneous injection - heparin 5000units twice a day subcutaneous injection - Anti-embolism (TED) stockings • Growth factors such as filgrastim biosimilar 30million units (300mcg) once a day subcutaneous from day +5 (stop when neutrophils are greater than 1x109/L for at least 24 hours, or greater than 3 on any occasion). This will not be supplied pre-admission, and to be prescribed on admission day +5. • Hormone replacement In menstruating women consider norethisterone 5mg three times a day oral to prevent menstruation. This may be stopped when the platelets are more than 50x109/L. • Mouthcare for the prophylaxis or treatment of mucositis in accordance with local or national guidelines. • Gastric protection with a proton pump inhibitor or a H2 antagonist according to local formulary choice: - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral • Hydration Encourage 2L oral fluids daily. If ambulatory patients are unable to maintain this (e.g. due to nausea), they should be admitted for intravenous hydration. Version 1.0 (December 2025) Page 4 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate Additional Information • Irradiated blood products must be used • Autologous stem cells/ bone marrow will be infused on day 0 References 1. Mummaneni, V., Kaul, S., Igwemezie, L.N. et al. Bioequivalence assessment of etoposide phosphate and etoposide using pharmacodynamic and traditional pharmacokinetic parameters. Journal of Pharmacokinetics and Biopharmaceutics 24, 313–325 (1996). https://doi.org/10.1007/BF02353515 2. Neon Healthcare Ltd. Etopophos 100mg Powder for Solution for Injection Summary of Product Characteristics. Electronic Medicines Compendium [Internet]. 2024. Available from: Etopophos 100 mg Powder for Solution for Injection - Summary of Product Characteristics (SmPC) - (emc) | 10514 3. Cancer Institute NSW – eviQ. Chemotherapy protocol: Autologous conditioning germ cell tumour TICE (cARBOplatin and etoposide) (part 2). [Internet]. 2011. Last reviewed 2022. Available from: 1178-Autologous conditioning germ cell tumour TICE (cARBOplatin and etoposide) (part 2) | eviQ Version 1.0 (December 2025) Page 5 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate REGIMEN SUMMARY Germ Cell – Amb TICE (part 2): Carboplatin and Etoposide phosphate Day -5 1. Aprepitant 125mg capsule oral 2. Dexamethasone 2mg oral or intravenous 3. Ondansetron 8mg oral or intravenous 4. Metoclopramide 10mg oral or intravenous 5. Sodium chloride 0.9% 500ml intravenous infusion over 60 minutes 6. Carboplatin AUC8 intravenous infusion in 500ml glucose 5% over 60 minutes Administration Instructions This recommended maximum dose is 1200mg based on a creatinine clearance of 125ml/min. 7. Etoposide 400mg/m2 intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Administration Instructions Etoposide phosphate (Etopophos) must be used for this protocol as solutions of conventional etoposide would exceed the maximum concentration of 0.4 mg/mL and may precipitate. 8. Sodium chloride 0.9% 1000ml intravenous infusion over 4 hours Take Home Medicines 9. Dexamethasone 2mg once a day in the afternoon for 3 days starting on day -5 10. Ondansetron 8mg once a day in the evening for 3 days starting on day -5, then take 8mg twice a day for 3 days. 11. Metoclopramide 10mg twice a day in the afternoon and evening for 3 days starting on day -5, then take 10mg three times a day for 3 days. Administration instructions –Please supply 28 tablets or an original pack as appropriate 12. Aciclovir 400mg three times a day for 28 days Administration Instructions Please supply 28 days or an original pack if appropriate. 13. Ciprofloxacin 250mg twice a day starting on day +1 Administration Instructions: Stop when neutrophils are greater than 1.0. Please supply 14 days with no stop date 14. Fluconazole 100mg oral once a day Administration instructions – stop when neutrophils are greater than 1.0 unless the patient remains on corticosteroids. Please supply 14 days with no stop date. 15. Nystatin 1ml four times a day Administration instructions – stop when neutrophils are greater than 1.0 unless the patient remains on corticosteroids. Please supply 1 x OP Version 1.0 (December 2025) Page 6 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate 16. Gastric Protection Administration Instructions The choice of gastric protection is dependent on local formulary choice and may include; - esomeprazole 20mg once a day oral - omeprazole 20mg once a day oral - lansoprazole 15mg once a day oral - pantoprazole 20mg once a day oral - rabeprazole 20mg once a day oral - cimetidine 400mg twice a day oral - famotidine 20mg once a day oral - nizatidine 150mg twice a day oral Please supply 28 days or the nearest original pack size. 17. Sodium Chloride 0.9% oral rinse 10mL four times a day Administration instructions – pharmacy please supply 50 x 10mL pods 18. Thromboprophylaxis according to local formulary choice To start on admission, on Day +5, unless the patient is deemed high risk. Continued until platelets are less than 50x109/L, or as directed by the consultant, according to local formulary choices: - dalteparin 5000units once a day subcutaneous injection - enoxaparin 40mg once a day subcutaneous injection - heparin 5000units twice a day subcutaneous injection Please supply 28 days or nearest original pack size. 19. Warning – Ensure take home medicines are supplied Day -4, day -3 20. Aprepitant 80mg once a day oral 21. Dexamethasone 2mg oral or intravenous 22. Ondansetron 8mg oral or intravenous 23. Metoclopramide 10mg oral or intravenous 24. Sodium chloride 0.9% 500ml intravenous infusion over 60 minutes 25. Carboplatin AUC8 intravenous infusion in 500ml glucose 5% over 60 minutes Administration Instructions This recommended maximum dose is 1200mg based on a creatinine clearance of 125ml/min. 26. Etoposide 400mg/m2 intravenous infusion in 250ml sodium chloride 0.9% over 30 minutes Administration Instructions Etoposide phosphate (Etopophos) must be used for this protocol as solutions of conventional etoposide would exceed the maximum concentration of 0.4 mg/mL and may precipitate. 27. Sodium chloride 0.9% 1000ml intravenous infusion over 4 hours Version 1.0 (December 2025) Page 7 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate Day -2, Day -1 Rest day Day 0 28. Chlorphenamine 10mg Intravenous bolus Administration instructions – to be given pre stem cell infusion 29. Paracetamol 1000mg Tablet Oral Administration instructions – to be given pre stem cell infusion 30. Stem Cell Return – see separate chart Version Date 1 09/12/2025 DOCUMENT CONTROL Amendment None Written By Alexandre Guedes Pharmacist Approved By Robert Lown Consultant This chemotherapy protocol has been developed as part of the chemotherapy electronic prescribing project. This was and remains a collaborative project that originated from the former CSCCN. These documents have been approved on behalf of the following Trusts; University Hospital Southampton NHS Foundation Trust All actions have been taken to ensure these protocols are correct. However, no responsibility can be taken for errors which occur as a result of following these guidelines. Version 1.0 (December 2025) Page 8 of 8 Germ Cell – Amb TICE (part 2): Carboplatin (AUC 8) and Etoposide phosphate
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/Media/UHS-website-2019/Docs/Chemotherapy-SOPs1/Germcell/AmB-TICE-Carboplatin-Etoposide.pdf

My m health COPD

Description
in partnership with myCOPD | Asthma mymhealth.com Improve your knowledge Keep track of your condition Perfect your inhaler technique Track your physical activity Asthma: 13 and over COPD: 18 and over much more! Pulmonary Rehab Your main online video course Nutrition A healthy diet can help manage your COPD. Walking Scenic walks in your own home Scan here To get access for free Ask your clinical team about the my mhealth app today! Your journey starts here Just a few steps to get started 1 Scan the QR code with your phone to register to the my mhealth platform for free 2 You’ll receive an activation email straight away! Check your inbox (including junk) for an email from donotreply@mymhealth.com 3 Click the link in the email to create your password Your account is now active and you are ready to log in 4 For the best experience, download the free my mhealth app to your smartphone or tablet using the QR code below If using a computer, you can login on mymhealth.com Scan QR to download Scan QR to download 5 iPhone or iPad inc Samsung, Motorola, Google Pixel Log in and set up your account! You’ll be asked a few quick questions and to choose your security preferences Have a question or require technical support? Our expert Customer Support team are on hand 8am-5pm, Monday-Friday (exc Bank holidays) Email us support@mymhealth.com or call on 01202 299583 Entering data and using the my mhealth app WILL NOT notify your clinical team to an issue or if you are feeling unwell
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/Media/UHS-website-2019/Docs/my-m-health-copd.pdf

Pain relief at home - patient information

Description
This factsheet explains the different types of pain relief medications you may be prescribed and their common side effects.
Url
/Media/UHS-website-2019/Patientinformation/Surgery/Pain-relief-at-home-2940-PIL.pdf
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